Students Come Back Changed

Posted in GUMC Stories

Steven Andelman never expected to be so wowed by the medicine he saw practiced in Ecuador. Physicians at the Hospital Eugenio Espejo in Quito — a large tertiary care center that cares for Ecuador’s poorest patients — seemed almost like wizards. They could diagnose a biliary tract tumor by touch, tuberculosis by listening and an infection in spinal vertebrae by tapping on bone.

“These physicians are true masters of physical diagnosis — I don’t think some of the things I saw would happen in an American hospital,” says Andelman, who just graduated from the Georgetown University School of Medicine with his M.D. degree. 

During his final block of classes at Georgetown University School of Medicine, Andelman took an international elective to provide, as he says, “a capstone to my time spent at Georgetown. My thought is that I would be able to utilize all that I learned over the past four years to help care for patients.”

Little did he know that the experience in April would add so much more to his education.

Andelman’s reaction mirrors what many fourth-year students who have taken the elective tell Irma Frank, DDS, who has directed the program for the past 20 years. “In fact, students have told me that they think the doctors they meet in this program are magicians,” she says with a laugh. “They say the doctors talk a lot to the patients and in that way, they diagnose their disease, and they explain the illness so the patients are well-informed and take part in their healing. Patients become well,” Frank says. “These are good clinicians. They get all the information they need from the patients without using scans and other advanced tests. They have to.”

She makes sure the students chosen for the elective go for the right reasons, based on the Georgetown mission of cura personalis. The international program is a draw for many fourth-year medical students at Georgetown, but Frank, who was born in Colombia, carefully selects the students that participate in international elective rotations in 20 countries at hospitals and universities that she has personally built relationships with. She sits down with all applicants to make sure they understand the difference between an international “trip” and an “educational program.” As in every elective, students are evaluated on their performance, and they are required to report their experiences. About 30 percent of the senior class participates in the elective.

There is a reason Frank has been described as the head and the heart of the program. Not only is she meticulous about the details, which includes a continuing eye on the safety of the students who participate, she also makes sure that students who cannot pay for travel expenses will have funding.

She freely admits that the program, which she was asked to start after Georgetown’s Dental School closed, eliminating her position as faculty in the school, is her life’s work. “You are exposing students to different situations that change their lives and make them better students, while following the mission of the medical center — academic excellence and service to others.”

One of the best experiences in med school

Angel Peng also was amazed — a word many students use — at how different the approach to medicine was in South Africa, compared with what she has learned and seen at Georgetown. “The attendings could guess a patient’s past medical history just by looking at them. They emphasize that diagnosis should be made by seeing, hearing and touching,” says Peng, who also received her M.D. in May. “Their physical examinations were the most comprehensive I’ve ever seen.”

Frank is not surprised that Peng appreciated the lessons that were offered to her this April in Cape Town. “A lot of students come back changed. Some have said that this elective was one of the best experiences they have had in their four years of medical school.

“It often isn’t easy for them,” she adds. “The clinics can be basic. Sometimes they don’t even have running water — but it doesn’t matter.”

Andelman is now starting a residency in orthopaedic surgery at Mount Sinai Hospital in New York. Andelman knows his “amazing” experience in Ecuador will help him “grow as a future physician. I will be taking care of patients in New York City from all over the world. Each patient will bring with them their own cultural background and their own perspective on health and healing. By having had the opportunity to experience a culture outside of the United States — to see how they interact with and form relationships with their physicians — I feel that I will have a better appreciation for my patients, regardless of their cultural background.”

Peng, who moved to New York City from China when she was six, is returning to the city for a residency in internal medicine. She is certain that the skills she acquired in Cape Town will help her become more intimate with patients and their backgrounds to the point that she will be able to assess clinical improvement with much more ease.

Chrissy Herforth also described her experience as “amazing.” Given her Irish ancestry, she chose to work with physicians on the stroke service at St. James Hospital in Dublin. She took away several lessons. One is that having a “ward room” with up to eight patients is very therapeutic to patients. “It created a sense of community and was especially conducive to patient rehabilitation after stroke,” she says. “Patients who suffered with depression, which is common after a stroke, typically did better in these larger rooms than in the private rooms.”

Herforth also appreciated the “tough love” physicians doled out to their patients. “They were a little more direct,” which had beneficial effects, she says. “This is something I hope to take with me in my future practice,” says Herforth, a recent graduate who will serve as a Navy physician after serving a residency.

(Published May 29, 2013)